1. U06-3222 #657376720 28yo Nigerian Canadian, born in Toronto HPI Presented with a several day history of intractable N&V, bilateral flank pain, fever and generally feeling unwell. Was seen in ER. Cr was normal and U/A showed 6-10 WBC, 26-50 RBC and occasional granular and hyaline casts. He was referred to Dr. Bradley who initiated a GN work-up. In the interim, the N&V continued and he was admitted to hospital a few days later. Cr remained normal. CK increased to > 500, and urine was + for myoglobin so he was treated for rhabdomyolysis. Several days following admission he acutely developed peripheral edema and ascites, N&V remain intractable. 48 hours following this, Cr began to rapidly increase from 80 - ~ 550.

2. U06-3222 #657376720 PMH: nil Abdominal U/S: increased renal echogenicity, edema of the bowel, ascites CT abdomen: Bowel wall edema Cr: 550, electrolytes N, CBC N ANCA, Ds-DNA, C4, protein electrophoresis = normal ANA +, IgA & IgG increased, C3 0.57, albumin 19 PE: mild hypertension, ascites, peripheral edema, decreased perianal and scrotal sensation, mild incontinence of stool and urine No skin or MSK abnormalities

3. IgG-Strong coarsely granular capillary loop staining IgA- Mild to moderate coarsely granular capillary loop staining IgM- Mild coarsely granular capillary loop staining C3- moderate coarsely granular capillary loop staining C1q- mild to moderate coarsely granular capillary loop staining Kappa-moderate coarsely granular capillary loop staining Lambda- moderate coarsely granular capillary loop staining Fibrin- Mild interstitial staining Albumin- mild hyaline droplet change in tubular cytoplasm IF

4. IgG

5. IgA

6. IgM

7. C3

8. Clq

9. Kappa

10. Lambda

11. Fibrin

12. Albumin

18. Diagnosis: Renal Biopsy Lupus nephritis Class V,Membranous lupus nephritis mixed with focal lupus nephritis Class IIIA with active lesions (2003 ISN/RPS Classification).